Cycling In-Bed Will Aid in Faster Recovery of Patients Admitted to Intensive Care Unit

Patients in the intensive care unit (ICU) may benefit greatly from early cycling while still in bed. It will help them recover faster. The study was conducted by a research team from McMaster University and St. Joseph's Healthcare Hamilton. The study gives a green signal to safely start in-bed cycling sessions with the critically ill, mechanically ventilated patients, early into their ICU stay.

Mechanical ventilation is a life support system that helps patients to breath when they cannot breathe on their own. It either supports breathing or completely controls breathing depending on the patient’s condition.

Uses

• Supply oxygen to lungs
• Get rid of carbon dioxide
• Ease breathing
• Control breathing in patients who have serious injury or illness that causes breathing to stop

"People may think that ICU patients are too sick for physical activity, but we know that if patients start in-bed cycling two weeks into their ICU stay, they will walk farther at hospital discharge," says the study's lead author Michelle Kho, an assistant professor in the School of Rehabilitation Science at McMaster University and physiotherapist at St. Joseph's Healthcare Hamilton.

TryCYCLE

The new study termed as “TryCYCLE”, builds on the findings that it is safe to start in-bed cycling sessions in patients admitted to the ICU, within four days of mechanical ventilation and it would be beneficial if the exercise is continued for the entire stay.

TryCYCLE is the first among a series of studies that will determine the effects of early in-bed cycling with critically ill patients.

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What ICU Admission Does to the Body

Patients who survive their ICU stay are at high risk for:

• Muscle weakness that starts within days of ICU admission
• Disability
• Muscle atrophy

The intensive care acquired muscle weakness is also known as neuromuscular weakness. This problem affects more than half of the adults admitted to the ICU for more than a week.

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The muscle weakness becomes apparent when an attempt is made to wean the patient from the ventilator.

Muscle atrophy is another frequent problem observed in patients in the Intensive Care Units. The term describes the disorder in the structure and in the function of the muscle, caused by a reduction in the muscle mass.

The incidence rates range from 25-90 % in patients with prolonged hospitalization.

The main cause for this is bed rest and immobilization. It mainly affects the musculoskeletal, cardiovascular and respiratory system.

A primary goal of treatment for the patients in the ICU is prevention of muscle weakness and wasting as it helps to reduce the time spent in ICU and finally improves the quality of patients’ life.

Testing the Effects of In-Bed Cycling

The research team studied the effects of cycling on ICU admitted patients for over a year.

They included 33 patients aged 18 years or older for their study. The patients needed mechanical ventilation and walked independently, prior to their admission.

A special motorized stationary in-bed cycling equipment was used for the study.

The exercise included 30 minutes of supine cycling for six days a week, using the bicycle affixed to the bed.

Study Findings

The research team found that early cycling within the first four days of admission among mechanically ventilated patients with stable blood flow is safe and feasible.

Patients started cycling within the first three days of ICU admission and cycled about 9 km on an average during their ICU stay.

"Patients' abilities to cycle during critical illness exceeded our expectations," says Kho.

Benefits of Cycling Among Critically-Ill

The general health advantages of cycling as an exercise for healthy individuals are manifold-

Strengthening of muscles- Cycling helps to strengthen and tone muscles of the thighs and calf.

Diabetes- It helps in controlling diabetes. The muscles use the glucose in the blood for energy and thus reduces the amount of sugar in blood.

Pain & Stress Management- Cycling is considered as a ‘releasing’ exercise. Releasing exercises help alleviate physiological issues like pain and psychological issues like tension and stress.

Weight management- Cycling helps in burning calories and shedding weight.

Reduces cancer risk- People who undertook moderate to high physical activity in their early and middle ages reduced their risk of cancer.

The advantages of cycling among the critically ill are two-fold:

• It causes speedy recovery among patients
• Alleviates the high cost for the health care system, associated with critical care.

Cycling targets the legs, especially the hip flexors. These muscles are most affected during bed rest. By strengthening these muscles, the overall health improves and patients may go home sooner, stronger and happier.

Conclusion

More research is needed to determine if this early cycling with critically ill patients improve their physical function.

The next step is to start the in-bed cycling study in a pilot randomized trial in many hospital ICUs.

The TryCYCLE study was funded by the Canadian Institutes of Health and was published in the journal PLOS ONE.

Intensive Care Unit Statistics

Annually, more than 5.7 million patients are admitted to intensive care units (ICUs) in the United States.

Approximately 20% of acute care admissions are to an ICU and up to 58% of emergency department admissions result in an ICU admission.

According to the American Hospital Association’s 2014 annual survey, all acute care hospitals have at least one intensive care unit (ICU), and approximately 55,000 critically ill patients are cared for each day.

From 2006 to 2010, the number of critical care beds in the United States increased 15%, from 67,579 to 77,809.

References:

1. Michelle E. Kho, Alexander J. Molloy, France J. Clarke, Daana Ajami, Magda Mccaughan, Kristy Obrovac, Christina Murphy, Laura Camposilvan, Margaret S. Herridge, Karen K. Y. Koo, Jill Rudkowski, Andrew J. E. Seely, Jennifer M. Zanni, Marina Mourtzakis, Thomas Piraino, Deborah J. Cook, ‘Canadian Critical Care Trials Group. TryCYCLE: A Prospective Study of the Safety and Feasibility of Early In-Bed Cycling in Mechanically Ventilated Patients.’ PLOS ONE, (2016) DOI: 10.1371/journal.pone.0167561
2. Mechanical Ventilation - (http://www.thoracic.org/patients/patient-resources/resources/mechanical-ventilation.pdf)
3. Health Benefits of Cycling - (https://www.organicfacts.net/health-benefits/other/health-benefits-of-cycling.html)
4. A stronger approach to weakness in the intensive care unit - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065060/)
5. Muscle Atrophy in Intensive Care Unit Patients - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315632/)

Source-Medindia